AB0327 DEVELOPING A CLINICAL ASSESSMENT TOOL FOR DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS: RESULTS FROM A SYSTEMATIC LITERATURE REVIEW AND FEASIBILITY ASSESSMENT
Authors: R. Singh, S. Chambers, A. Baranskaya, A. Filer, M. Falahee, K. Raza, A. Croft
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Management of difficult-to-treat rheumatoid arthritis (D2T-RA) is challenging since poor treatment response also incorporates non-inflammatory symptoms that can mimic or amplify pain and scores on composite disease activity measures. Identification of modifiable non-inflammatory factors is vital to improve health outcomes and minimise harm from inappropriate escalation of drug therapy. <h3>Objectives</h3> To develop and assess feasibility of a systematic, evidence-based clinical assessment tool for the identification of modifiable non-inflammatory factors in D2T-RA. <h3>Methods</h3> A systematic literature search of PubMed, Embase and Web of Science databases for studies pertaining to D2T-/treatment refractory RA was undertaken from database inception to October 2021. Studies were screened against inclusion/exclusion criteria, and further excluded if deemed to have a high risk of bias. Data pertaining to factors associated with treatment non-response were extracted from eligible papers and categorised to inform composition of the clinical assessment tool. Through patient involvement, the proposed tool's components were assessed for their feasibility and ease of capture in an outpatient setting. Eight patients fulfilling EULAR definition of D2T-RA were recruited from a single centre. Clinical data and responses to relevant questionnaires mapped to the clinical tool, including: Patient Health Questionnaire-9 (PHQ-9), Brief Illness Perception Questionnaire (B-IPQ), Beliefs about Medicines Questionnaire-Specific (BMQ-S), Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) and Medication Adherence Report Scale-5 (MARS-5) were collected. <h3>Results</h3> 1154 records were screened, of which eight studies informed the development of a clinical assessment tool. Modifiable factors including raised BMI, smoking status, non-adherence, and co-morbidities, such as fibromyalgia and worse mental health were identified and incorporated into an initial tool. These factors were apparent and readily assessed within a local cohort of D2T-RA patients (Table 1). In summary, data from this cohort revealed a low burden of classified fibromyalgia, mild depression severity, and responses in keeping with a high illness concern. Despite general acceptance of pharmacological treatments, 'ever' non-adherence, classified as a response other than 'never' within the MARS-5 questionnaire was noted in two, five, and three patients regarding steroids, csDMARDs and b/tsDMARDs respectively. <h3>Conclusion</h3> Following a systematic review of the literature, we identified several modifiable factors that inform the development of a clinical assessment tool in D2T-RA and can be readily evaluated in an outpatient setting. A holistic approach is required to address both inflammatory and non-inflammatory aspects of D2T-RA. The development of an evidence-based clinical assessment tool is the first step in providing this, by identifying and targeting patient-specific non-inflammatory modifiable factors, in conjunction with pharmacological escalation. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Ruchir Singh: None declared, Sachin Chambers: None declared, Aliaksandra Baranskaya: None declared, Andrew Filer Consultant of: Abbvie, Roche, Janssen, Grant/research support from: BMS, Roche, UCB, Nascient, Mestag, GSK, Janssen, Marie Falahee: None declared, Karim Raza Consultant of: Abbvie and Sanofi, Grant/research support from: Bristol Myers Squibb, Adam Croft: None declared.